Outcomes of cardiac surgery with left atrial appendage occlusion versus no Occlusion, direct oral Anticoagulants, and vitamin K Antagonists: A systematic review with Meta-analysis

Nso, Nso; Nassar, Mahmoud; Lakhdar, Sofia; Shaukat, Tanveer; Guzman, Laura; Alshamam, Mohsen; Foster, A.; Bhangal, Rubal; Badejoko, Solomon; Ngonge, Anthony Lyonga; Tabot-Tabot, Mpey; Mbome, Yolanda; Rizzo, Vincent; Munira, Most Sirajum; Thambidorai, Senthil

doi:10.1016/j.ijcha.2022.100998

Cited by 7 publications

(5 citation statements)

References 51 publications

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“…LAAOS III was not designed to resolve whether oral anticoagulation can be safely stopped after S-LAAO; at hospital discharge, >80% of subjects in both groups were receiving OAC, with >75% on OAC at the 3-year visit. 1 A systematic review and meta-analysis focusing on the effects of anticoagulation found no statistically significant difference in stroke rates of S-LAAO/no S-LAAO subjects on OAC versus off OAC, with high heterogeneity noted for both ischemic events and mortality, 14 and findings are subject to confounding by indication and the potentially beneficial effects of surgical AF ablation. The LAACS (Left Atrial Appendage Closure with Surgery) study of 187 subjects undergoing CABG, valve surgery, or both who were randomized to S-LAAO versus no S-LAAO showed a reduction in the risk of stroke in the S-LAAO group, independent of anticoagulation status.…”

Section: Prevention Of Thromboembolismmentioning

confidence: 99%

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Joglar,

Chung,

Armbruster

et al. 2024

Circulation

370

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AIM The “2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation” provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the “2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation” and the “2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation” have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.

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Section: Prevention Of Thromboembolismmentioning

confidence: 99%

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Joglar,

Chung,

Armbruster

et al. 2024

Circulation

370

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“…22 Similar results for all-cause mortality, stroke, and thromboembolic complications were found by other studies across different time periods, follow-up duration, and case-mix, even including in patients with durable left ventricular assist devices. [22][23][24][25][26] LAAO methods with demonstrated durability include clip application, epicardial stapling and resection, and endoatrial double-layer longitudinal suture closure. 21…”

Section: Clip It-class I Recommendation To Obliterate the Appendage I...mentioning

confidence: 99%

Noteworthy in Cardiothoracic Surgery 2023

Rove,

Cain,

Hoffman

et al. 2024

Semin Cardiothorac Vasc Anesth

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Noteworthy in Cardiothoracic Surgery 2023 summarizes a few of the most high-impact trials and provocative trends in cardiothoracic surgery and transplantation this past year. Transplantation using organs procured from donation after circulatory death (DCD) continues to increase, and the American Society of Transplant Surgeons released recommendations on best practices in 2023. We review a summary of data on the impact of DCD on heart and lung transplantation. There has been increased interest in extracorporeal life support (ECLS), particularly after the COVID-19 pandemic, and we review the results of the highly discussed ECLS-SHOCK trial, which randomized patients in cardiogenic shock with planned revascularization to ECLS vs usual care. With improving survival outcomes in complex aortic surgery, there is a need for higher-quality evidence to guide which cooling and cerebral perfusion strategies may optimize cognitive outcomes in these patients. We review the short-term outcomes of the GOT ICE trial (Cognitive Effects of Body Temperature During Hypothermic Circulatory Arrest), a multicenter, randomized controlled trial of three different nadir temperatures, evaluating outcomes in cognition and associated changes in functional magnetic resonance imaging. Finally, both the Society of Thoracic Surgeons (STS) and the American College of Cardiology, American Heart Association, American College of Chest Physicians and Heart Rhythm Society (ACC/AHA/ACCP/HRS) updated atrial fibrillation guidelines in 2023, and we review surgically relevant updates to the guidelines and the evidence behind them.

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“…33 Moreover, limitations of that multicentre randomized trial 33 included the main application of LAAOS III trial 33 findings to surgical LAA occlusion as a concomitant (not stand-alone) procedure, the relatively brief follow-up (mean of 3.8 years), and the lack of information about the relative efficacy of LAA occlusion in comparison with OAC. 33 In a recent systematic review with meta-analysis, importantly, Nso et al 35 affirmed that complete replacement of OAC by surgical LAA occlusion remains unlikely, probably due to the limited number of studies comparing LAA occlusion to OAC as well, hence producing weak results concerning that hypothesis.…”

Section: Current Indications For Left Atrial Appendage Occlusionmentioning

confidence: 99%

Lights and shadows on left atrial appendage occlusion: mind the gap in knowledge and think twice on long-term outcomes

Dell’Angela,

Nicolosi

2024

Journal of Cardiovascular Medicine

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Ischemic stroke prevention represents a crucial concern in health systems, being associated with high morbidity and mortality. Atrial fibrillation is associated with 15–20% of ischemic strokes, in the presence of thrombus in the left atrial appendage in 90% of patients with nonvalvular atrial fibrillation. Oral anticoagulation represents the standard of care. However, left atrial appendage occlusions have been developed for selected patients with nonvalvular atrial fibrillation. With regard to the latter, particularly, some important concerns have been raised on the selection of patients potentially amenable to the procedure, seemingly emphasizing a gap in knowledge, real-life clinical practice, and current management guidelines. In light of the recent evidence regarding the current indications for management of left atrial appendage in presence of nonvalvular atrial fibrillation, the purpose of this critical review is to highlight the blind spots of left atrial appendage occlusion indications, taking into account the evidence-based mid- to long-term outcomes. Apparently, many unsolved concerns and problems are still present, mainly including mid- and long-term device-related potential complications, the possibility of concurrent sources of embolization, ethical and economic issues. Furthermore, larger, well designed, long-term, multicentric, and more inclusive studies, as well as shared/integrated registries are needed, aiming at comparing direct oral anticoagulation with left atrial appendage occlusion in the long run.

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Outcomes of cardiac surgery with left atrial appendage occlusion versus no Occlusion, direct oral Anticoagulants, and vitamin K Antagonists: A systematic review with Meta-analysis

Cited by 7 publications

References 51 publications

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Noteworthy in Cardiothoracic Surgery 2023

Lights and shadows on left atrial appendage occlusion: mind the gap in knowledge and think twice on long-term outcomes

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